We are proposing to hold an invitational conference to examine issues related to the identification and development of outcome measures, and their accompanying risk adjustment models, in the electronic health record (EHR) environment. This conference will address methodological issues that will form the basis for a demonstration project to develop risk- adjusted outcome measures generated from the EHR. These risk-adjusted outcome measures would be useful for oversight, internal quality improvement, public reporting, pay-for- performance and consumer decision-making. Outcome measures assess the results of the patient's health care system encounter, and they are particularly useful for evaluating the quality of that care. Due to difficulties in locating and collecting accurate and comprehensive data on health outcomes, performance measurement efforts have primarily focused on the processes of care. Yet, in most areas, the relationship between the processes of care being measured and specific health outcomes has yet to be established. The introduction of the EHR across the broad spectrum of health care is expected to provide new opportunities to access and gather data upon which outcome measures can be based. In order to accurately compare performance across providers and over time outcome measures require risk adjustment. The quality and usefulness of an outcome measure depends on the quality of the risk adjustment model accompanying it. Widespread EHR implementation holds the promise of supplying more and better data upon which to construct these models. The following questions will be explored at the conference. (1) How can EHR data be used to develop risk models for existing mortality and readmission outcome measures? (2) What EHR data originating from outside the hospital walls will be useful for the development of risk adjusted outcome measures in the hospital setting, and in settings outside of the hospital? (3) What new risk adjusted outcome measures (beyond mortality and readmission rates) can be generated through the use of EHR data? (4) What are the challenges and barriers to the development of risk adjusted outcome measures in the EHR environment, and how can these barriers be overcome? Information generated by the conference will form the basis of a demonstration project during which risk adjusted outcome measures useful for monitoring and improving health care quality will be developed and tested using EHR data. PUBLIC HEALTH RELEVANCE: This conference will address methodological issues that will form the basis for a demonstration project to develop risk-adjusted outcome measures generated from the EHR. It will pave the way for a significant increase in the number of risk-adjusted outcome measures available for oversight, internal quality improvement, public reporting, pay-for-performance and consumer decision-making, across a wider variety of health care settings.